Drive time to cardiac rehabilitation: at what point does it affect utilization?
1 Department of Geography, Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
2 School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
3 Department of Medicine - Division of Cardiology, London Health Sciences Centre and University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
4 Department of Behavioural Sciences and Health, University Health Network - Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
5 Department of Psychiatry, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
International Journal of Health Geographics 2010, 9:27 doi:10.1186/1476-072X-9-27Published: 4 June 2010
A 30 minute drive time threshold has often been cited as indicative of accessible health services. Cardiac rehabilitation (CR) is a chronic disease management program designed to enhance and maintain cardiovascular health, and geographic barriers to utilization are often cited. The purpose of this study was to empirically test the drive time threshold for CR utilization.
A prospective study, using a multi-level design of coronary artery disease outpatients nested within 97 cardiologists. Participants completed a baseline sociodemographic survey, and reported CR referral, enrollment and participation in a second survey 9 months later. CR utilization was verified with CR sites. Geographic information systems were used to generate drive times at 60, 80 and 100% of the speed limit to the closest CR site from participants' homes, to take into consideration various traffic conditions. Bivariate analysis was used to test for differences in CR referral, enrollment and degree of participation by drive time. Logistic regression was used to test drive time increments where significant differences were found.
Drive times were generated for 1209 outpatients. Overall, CR referral was verified for 523 (43.3%) outpatients, with verified enrollment for 444 (36.7%) participating in a mean of 86.4 ± 25.7% of prescribed sessions. There were significant differences in CR referral and enrollment by drive time (ps < .01), but not degree of participation. Logistic regression analysis (ps < .001) revealed that the drive time threshold at 80% of the posted speed limit for physician referral may be 60 minutes (OR = .26, 95% CI: 0.13-0.55), and the threshold for patient CR enrollment may also be 60 minutes (OR = .11, 95% CI: 0.04-0.33).
Physicians may be taking geography into consideration when referring patients to CR. Empirical consideration also reveals that patients are significantly less likely to enroll in CR where they must drive 60 minutes or more to the closest program. Once enrolled, distance has no significant effect on degree of participation.